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Payment methodology updated for MA admissions to home health agencies, starts Jan. 1, 2020

The Centers for Medicare & Medicaid Services is implementing a new payment methodology affecting Medicare Plus Blue^SM PPO members, the Patient-Driven Groupings Model, effective Jan. 1, 2020, for home health agencies. Read more in the CMS press release or CMS Patient-Driven Groupings Model (PDF). This was announced in a Dec. 20, 2019, web-DENIS message.

We’ve discontinued our fax line for the Behavioral Health Incentive Program

We suspended the BHIP self-reported Therapeutic Alliance and Primary Care Physician Contact measures in July 2018. Since these submissions are no longer accepted, we’ve discontinued the BHIP fax line. See this information on Page 20 of the January–February 2020 BCN Provider News.

Sign up for additional training webinars

We’re continuing our series of training webinars for health care providers and staff. To find out more and/or to register, see Page 6 of the January–February 2020 BCN Provider News or the January 2020 issue of The Record.

Holiday office closings

Blue Cross and BCN offices will be closed Jan. 20 (Martin Luther King Jr. Day).

e-referral upgrades coming in February

Two new enhancements are coming to the e-referral system to simplify the users’ experience. The expected go-live date for these is mid-February 2020. The changes include:

• Individual users will be able to flag referrals and authorizations that they are "watching."
• A new feature will display unread communications with a blue dot envelope icon.

Upcoming Learning to use the New Features of e-referral webinars will be available starting in January. Read more on Page 44 of the January–February 2020 BCN Provider News and the January 2020 issue of The Record.

How to submit multiple-line surgery claims for a hospital-based facility

When submitting a multiple-line surgery in a hospital-based facility to BCN, there are guidelines you need to follow for correct reimbursement. One of the frequent errors we receive is submitting each surgery line with charges. For more information, including submission instructions, see Page 38 of the January–February 2020 BCN Provider News.

New tools available

We’ve updated several flyers to assist you with your Blue Cross and BCN patients:

• 2020 products at a glance — These flyers are general summaries of Blue Cross and BCN products, including the product name, prefix and brief description.
• Finding your plans and networks — Shows you how to use the online provider search to confirm which products you accept.
• Keep office information secure — Offers tips on how providers can make their patients’ information more secure.

The 2020 products at-a-glance and Finding your plans and networks flyers can be found on web-DENIS in the BCN Provider Publications and Resources page under BCN Products or the BCBSM Newsletters and Resources page under Products and Networks. The Keep office information secure flyer can be found on ereferrals.bcbsm.com under Quick Guides.

Reminder: Blue Cross and BCN now accepting applied behavior analysis claims with 2019 procedure codes

Blue Cross and BCN began accepting claims for behavior analysis services billed with the following codes, for dates of service on or after June 1, 2019: *97151, *97152, *97153, *97154, *97155, *97156, *97157, *97158, *0362T and *0373T.

Claims billed with the following codes will still be honored: H0031, H0032, H2019, H2014, S5108 and S5111. For more information, see Page 17 of the November–December 2019 BCN Provider News or the July 2019 issue of The Record.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.

Star Quality news: Blue Cross and BCN earn 4 stars

The Centers for Medicare & Medicaid Services announced the 2020 star ratings. Every year, CMS announces ratings for Medicare Advantage plans, which range from 1 (lowest) to 5 (highest) stars. Blue Cross and BCN received an overall 4.0-star rating from CMS. Read more on Page 8 of the November–December 2019 BCN Provider News or the December 2019 issue of The Record.